Corticosteroids in fistulising Crohn’s: more harm than good ▸

Corticosteroids have been a mainstay of therapy for acute flares of Crohn’s disease because of their rapid relief of symptoms. Side effects such as bone loss and growth retardation are well documented, and recent papers have confirmed postoperative infective complications (for example, Gastroenterology 2003;125:320), in contrast with thiopurines which are not associated with increased risk. In this paper from Liverpool, the authors performed a retrospective case control study to quantify the risk of intra-abdominal or pelvic abscess. They collected all patients with perforating Crohn’s disease (n = 98) over eight years, representing 23% of their Crohn’s patients. After excluding those with postoperative abscesses or where prescribing data were incomplete, they analysed 86 patients, of whom 29 had abdominal or pelvic abscesses. Twenty six (90%) patients had received corticosteroids (versus 49% of the remaining patients who either had abdominal fistulae without abscess or perianal disease), with an odds ratio of 8.98 (2.4–33). Risk was greater with prednisolone over 20 mg, or duration of more than three months. In a second analysis, 12 patients with abdominal or pelvic abscesses after 1998 were compared with 24 matched patients with non-perforating disease with similar activity. Eleven of 12 abscess patients had received …